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Swedish Urology Group Request Medical Records free printable template

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Print Form Swedish Urology Group, PC 1101 Madison St., Suite 1400 * Seattle, WA 98104 * Tel 2063866266 * Fax 2066221052 John E. Keen, M.D. * Phillip H. Chapman, M.D. * Thomas C. Green, M.D. Erik L.
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How to fill out Swedish Urology Group Request Medical Records From

01
Obtain the Swedish Urology Group Request Medical Records form from their website or office.
02
Fill out your personal information, including your full name, date of birth, and contact details.
03
Provide the specific dates of service for which you are requesting records.
04
Indicate the type of medical records you wish to receive (e.g., consultation notes, test results).
05
Sign and date the form to authorize the release of your medical records.
06
Submit the completed form to the Swedish Urology Group via email, mail, or in person.

Who needs Swedish Urology Group Request Medical Records From?

01
Patients seeking access to their medical history for personal review.
02
Healthcare providers who require patient records for continuity of care.
03
Insurance companies needing documentation for claims processing.
04
Lawyers or legal representatives involved in medical-related cases.
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Swedish Urology Group Request Medical Records From is a document used to authorize the release of medical records from a patient's healthcare provider to the Swedish Urology Group.
The patient or their authorized representative is required to file the Swedish Urology Group Request Medical Records From.
To fill out the form, provide the patient's personal information, specify the medical records requested, and sign and date the authorization form.
The purpose of the form is to facilitate the transfer of a patient's medical records to ensure continuity of care and communication between healthcare providers.
The information that must be reported includes the patient's name, date of birth, contact information, the specific records requested, and the signature of the patient or their representative.
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